Provider Demographics
NPI:1295779197
Name:KHOURI, SAMI M (MD)
Entity type:Individual
Prefix:
First Name:SAMI
Middle Name:M
Last Name:KHOURI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1580 CREEKSIDE DR
Mailing Address - Street 2:STE 260
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630
Mailing Address - Country:US
Mailing Address - Phone:916-984-7870
Mailing Address - Fax:916-984-7871
Practice Address - Street 1:1580 CREEKSIDE DR
Practice Address - Street 2:STE 260
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630
Practice Address - Country:US
Practice Address - Phone:916-984-7870
Practice Address - Fax:916-984-7871
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2020-08-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA60690207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A606900Medicaid
CA00A606900Medicaid
00A606900Medicare ID - Type Unspecified